Fifth disease
Alternative names
Parvovirus B19; Erythema
infectiosum; Slapped cheek
Definition
Fifth disease is an acute
viral disease characterized by mild symptoms and
a blotchy rash beginning on the cheeks and spreading
to the extremities.
Causes
and risks
Fifth disease is caused by
the human parvovirus B19 agent. It occurs most
often during the spring with localized outbreaks
in preschoolers or school-age children and adolescents.
It is spread by respiratory secretions and the
duration of the illness is usually five days.
However, the rash may recur for several weeks
and may be brought on by exposure to sunlight,
heat, exercise, fever, or emotional stress.
Erythema infectiosum usually begins with bright
red cheeks producing a "slapped-cheek" appearance.
Following this, a rash appears on the extremities
and trunk. The rash fades centrally giving a lacy
(reticulated) appearance to the rash. The rash
fades over a period of 1-2 weeks. This illness
is seldom associated with fever.
Parvovirus B19 is thought to cause other disease
manifestations. In healthy adults it may be responsible
for an infectious arthritis (particularly in women).
In individuals with AIDS (or other immunocompromised
persons) it may produce a profound anemia. This
form of anemia is called 'transient aplastic crisis'.
The incidence of parvovirus B19 infection is
unknown, but studies suggest that 40% to 50%
of adults have antibodies to the virus. This
indicates a high degree of infection, and also
suggests that many infections go unnoticed.
Prevention
This is a contagious viral
disorder. At this time, there is no vaccine or
other proven prevention.
Symptoms
- Rash, first appearing on the cheeks, often
called "slapped cheeks"
- A rash spreading to the extremities about
one day later, often has a "lacy" appearance
(looks like lace)
- Headache (mild)
- Joint pain also called arthralgia (mild)
Signs
and tests
The patient is examined for the appearance
and pattern of the rash. The appearance of the
rash usually makes the diagnosis straight forward.
Antibody titer studies for parvovirus B9 are
available, although they are rarely performed.
They can be obtained through the Centers for
Disease Control (CDC) and some state health
departments.
Viral titers for parvovirus B19 are usually
obtained when trying to diagnose 'transient
aplastic crisis' and persistant anemias, occasional
manifestations of parvovirus B19 infection in
individuals with sickle cell anemia, hemolytic
anemias, HIV infection, and other types of immunodeficiency.
Virus studies may also be obtained when there
is a question of exposure in a pregnant mother
whose immune status is not known.
Treatment
No treatment is usually required
for fifth disease in children. If fever (unlikely)
or joint discomfort is present then acetaminophen
- oral may be given.
Prognosis
Since this is a mild and
benign viral infection, complete recovery can
be expected. |
